Disclosures: Jason Lew, DO: No financial relationships or conflicts of interest

Case Diagnosis: 21-year-old female with supplemental motor area syndrome after oligodendroglioma resection.

Case Description or Program Description: A 21-year-old female without past medical history who presented with new onset seizures, found to have oligodendroglioma which was resected with frontal craniotomy. Post-operatively, she had new left-sided hemiplegia secondary to supplemental motor area syndrome (SMA). Upon admission to acute inpatient rehabilitation, she had complete left hemiplegia without any voluntary movement. She also had noted anxiety for which she was seen by rehab psychology and psychiatry. She was started on SSRI and weaned off of benzodiazepines with significant improvement.

Setting: Acute Inpatient Rehabilitation Hospital

Assessment/Results: Initially she was minimum-moderate assist for mobility and required moderate to maximum assist for most ADLs. She had mild to moderate deficits in memory, concentration, problem-solving, as well as right gaze preference with left neglect. The patient progressed remarkably, with quick return of left leg function followed by left arm. On discharge, she was supervision to independent with ADLs and mobility without a device.

Discussion (relevance): SMA syndrome can result from resection of tumors involving the dominant hemisphere. SMA syndrome can present with complete akinesia and mutism. Motor deficits are most frequently secondary to impaired initiation of the contralateral limbs. Generally, prognosis for recovery is favorable, with most patients recovering from a few weeks to months. However, movement initiation is often the most persistent disabling symptom from SMA and is important to be addressed early with a structured rehabilitation program.

Conclusions: While SMA syndrome is generally a temporary condition, it is often of high severity and can be debilitating, especially in this case of a previously healthy 21 year old. Early acute inpatient rehabilitation was critical for her quick return to prior level of function. A multi-disciplinary approach for both her physical and mental health allowed her to maximize her recovery with a short acute inpatient rehabilitation stay.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/supplemental-motor-area-syndrome-after-oligodendroglioma-resection/